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NPI Code Detail

MEDICARE: WESLEY LYDON

MEDICARE: WESLEY LYDON
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225400000XRehabilitation Practitioner

General Provider Information

NPI Number : 1457650319
Entity Type Code : Individual
Provider Name (Legal Business Name) : WESLEY LYDON
Provider Business Mailing Address
First Line : 111 E TELEGRAPH ST
Second Line : SUITE 204
City : CARSON CITY
State : NV
Zip : 89701-4208
Country : US
Telephone Number : 775-885-7790
Fax Number : 775-885-7791
Provider Business Practice Location Address
First Line : 755 N ROOP ST
Second Line : SUITE 211
City : CARSON CITY
State : NV
Zip : 89701-3113
Country : US
Telephone Number : 775-885-7790
Fax Number : 775-885-7791
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/17/2011
Last Update Date : 05/17/2012

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Directions to “ WESLEY LYDON ” Practice Location

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